A B S T R A C T Arterial concentrations and net substrate exchange across the leg and splanchnic vascular bed were determined for glucose, lactate, pyruvate, and glycerol in healthy postabsorptive subjects at rest and during 40 min of exercise on a bicycle ergometer at work intensities of 400, 800, and 1200 kg-m/min.Rising arterial glucose levels and small decreases in plasma insulin concentrations were found during heavy exercise. Significant arterial-femoral venous differences for glucose were demonstrated both at rest and during exercise, their magnitude increasing with work intensity as well as duration of the exercise performed. Estimated glucose uptake by the leg increased 7-fold after 40 min of light exercise and 10-to 20-fold at moderate to heavy exercise. Blood glucose uptake could at this time account for 28-37% of total substrate oxidation by leg muscle and 75-89% of the estimated carbohydrate oxidation.Splanchnic glucose production increased progressively during exercise reaching levels 3 to 5-fold above resting values at the heavy work loads. Close agreement was observed between estimates of total glucose turnover during exercise based on leg glucose uptake and splanchnic glucose production. Hepatic gluconeogenesis -estimated from splanchnic removal of lactate, pyruvate, glycerol, and glycogenic amino acids-could supply a maximum of 25% of the resting hepatic glucose production but could account for only 6-11% of splanchnic glucose production after 40 min of moderate to heavy exercise.It is concluded that: (a) blood glucose becomes an increasingly important substrate for muscle oxidation dur-

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1. An indicator-dilution technique was used to determine human leg blood flow at rest and during exercise. The method is based on the infusion of Indocyanine Green into the femoral artery with blood sampling from the femoral vein at the level of the inguinal ligament. Evidence for mixing of dye and blood is presented, based on the finding of equal dye concentrations at two different sampling levels in the femoral vein. The minimum time of infusion required for equilibration at rest is 3 min and during exercise 1 min 20 s.2. Leg blood flow was measured in eight healthy athletic subjects at rest and during upright exercise on a bicycle ergometer at 400, 800 and 1200 kpm/min. Linear relationships were found between blood flow on the one hand and work intensity and pulmonary oxygen uptake on the other.3. Leg oxygen uptake was measured as the product of blood flow and femoral arterio-venous oxygen difference. Linear regressions were found for leg oxygen uptake in relation to both work intensity and pulmonary oxygen uptake. Leg mechanical efficiency during exercise averaged 34%. 4. A formula for the approximate calculation of leg blood flow is suggested, based on the pulmonary oxygen uptake and the femoral arterio-venous oxygen difference.The quantitative study of peripheral circulatory dynamics and limb metabolism in human subjects requires methods for measurement of blood flow which can be applied in a variety of clinical situations. Such methods do not appear to be available for leg blood flow determination. Although the indicator-dilution principle, which has been widely used for the determination of cardiac output, would seem to be applicable in the study of regional circulation, several theoretical objections and practical difficulties have limited its usefulness.If blood flow in an extremity is to be measured by the indicator-dilution method, several conditions must be fulfilled (Zierler, 1961).

Eighteen patients with severe COPD and seven healthy control subjects 64.0 +/- 2.2 and 66.8 +/- 1.4 yr of age, respectively (mean +/- SEM), were investigated. Arterial blood gas analysis, dynamic lung volumes, and muscle biopsy specimens from the quadriceps femoris muscle were performed. The muscle biopsies were analyzed for citrate synthase (CS), succinic acid dehydrogenase (SDH), 3-hydroxyacyl-CoA dehydrogenase (HAD), phosphofructokinase (PFK), and lactate dehydrogenase (LDH) activities and related to protein content. The PFK activity was higher in the COPD group than in the control group (+34%, p < 0.05). CS showed a group difference in the opposite direction (-29%, p < 0.05). LDH activity followed PFK and tended to be higher in the patient group (+27%, NS), whereas SDH (-31%, NS) and HAD (-28%, NS) mirrored the CS results. Muscle protein concentration tended to be lower in the COPD group (-14%, NS). There were no significant changes in enzyme activity after 7 mo of long-term oxygen therapy (n = 6). These results indicate adaptation in the form of augmented glycolysis (PFK), and decreased aerobic metabolism (CS) in the quadriceps femoris muscle in patients with advanced COPD.

Diabetes occurs frequently in patients with pancreatic cancer. To investigate the impact to tumour removal, seven patients were studied before and after 85 per cent subtotal pancreatectomy for adenocarcinoma of the pancreas. The frequency of diabetes was determined by the oral glucose tolerance test. Fasting levels of C peptide and insulin were measured in plasma, and insulin secretion was investigated by hyperglycaemic glucose clamp and glucagon stimulation. Six of the seven patients were diabetic before surgery and four required insulin treatment. Improvements in diabetic status and glucose metabolism were found in all seven patients after operation, as demonstrated by increased glucose metabolic capacity during hyperglycaemia. This occurred despite a postoperative reduction in insulin secretion and is explained by the observed augmentation of whole-body insulin sensitivity after surgery. A diabetogenic factor may be produced by pancreatic adenocarcinoma that may be responsible, directly or indirectly, for the high frequency of diabetes in patients with pancreatic cancer.